Lumbosacral orthosis can improve postural control in older adults with chronic low back pain

Lumbosacral orthosis can improve postural control in older adults with chronic low back pain | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Lumbosacral orthosis can improve postural control in older adults with chronic low back pain Régis M.-L. d'Assomption, Christian Larivière, Hakim Mecheri, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8022404/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Feb, 2026 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted 11 You are reading this latest preprint version Abstract Background Older adults with chronic low back pain may report poor postural control and increased fall risks. Possible key mechanisms are altered lumbar spine proprioception, stiffness and mobility, which could be enhanced through lumbar stabilization interventions. To evaluate the immediate effects of two lumbar stabilization approaches on postural control measures, namely a lumbosacral orthosis and the abdominal drawing-in maneuver. Methods 57 older adults (> 65 yrs): 22 with chronic low back pain and 35 healthy controls performed two trials (30 s) of a semi-tandem balance task on a force platform, while three experimental conditions were randomly assessed: 1) control (without lumbar stabilization), 2) lumbosacral orthosis and 3) the abdominal drawing-in maneuver. Linear variables derived from the platform center of pressure were computed (mean amplitude, ellipse area, sway velocity and frequency) as outcomes. Results No group × condition interactions were significant. However, chronic low back pain individuals showed significantly ( p ≤ .03) poorer postural control than healthy controls for 3/7 center of pressure parameters. Significant experimental condition effects ( p < .01) were also observed. The lumbosacral orthosis reduced center of pressure sway as compared to control (13%) and the abdominal drawing-in maneuver (15%) mainly for sway center of pressure velocity, while the abdominal drawing-in maneuver deteriorated postural control (23 to 39%) comparatively to the other two conditions. Conclusion Lumbosacral orthosis improved postural control across some center of pressure parameters, while the abdominal drawing-in maneuver degraded performance. These results have implications for clinical decision-making to promote fall prevention and sustainable health for older adults with and without chronic low back pain. Clinical trial number: Not applicable. Aging Lumbar spine Rehabilitation Chronic pain Falls Figures Figure 1 Figure 2 Figure 3 1.Introduction A systematic review, summarizing international data, reported a high prevalence of low back pain (75%) in older adults in developed countries ( 1 ). Although this disorder is multifactorial and often non-specific, age can be one of the most important risk factors for developing chronic low back pain (CLBP) ( 2 , 3 ). Multiple mechanisms related to proper aging could explain this high prevalence, such as degenerative changes in spinal discs and joints, loss of muscle mass and function (sarcopenia), lifestyle and altered pain processing in the central nervous system, all contributing to persistent pain in older adults ( 4 ). Although it is not known whether it is a cause or a consequence, some groups of individuals with CLBP are also characterized by balance impairments. This is evidenced in reviews with meta-analyses in young ( 5 ) and older adults ( 6 ), with the largest effects sizes seen during more challenging balance tasks and when self-reported pain intensity was higher, as least in young adults ( 5 ). In fact, experimentally induced low back pain in healthy individuals engenders neuromuscular adaptations during different postural perturbation tasks ( 7 ). Induced pain in the lower limbs also decreases balance control ( 8 ) and more so as pain intensity increases ( 9 ). A better postural control is naturally achieved by increasing joint stiffness, which is possible by cocontracting agonist and antagonist muscles surrounding the joints involved, especially during more difficult balance tasks ( 10 ). Cocontraction increases joint impedance, which can reduce motor noise (or kinematic variability) by acting as a mechanical filter. Motor noise sometimes increasing with aging ( 11 , 12 ), older adults have increased levels of cocontraction ( 13 ) as a strategy to suppress variability ( 14 ). Likewise, in response to pain, people with CLBP redistribute muscle activity across back and abdominal trunk muscles in an individual-specific non-stereotypical manner, but all responses increasing spine stability ( 15 ). Although the link with spine stability was not performed, ( 16 ) observed this type of trunk muscles activity redistribution during one-legged stance balance task, people with CLBP and older adults responding differently than their corresponding healthy and young control groups, respectively. Whether cocontraction strategies are used to protect the lumbar spine from further pain or to improve postural control, the signal-dependent noise (SDN) phenomenon predicts that this may have an opposite effect on postural control because as muscle contraction increases, more variability might be introduced into the movement. Effectively, SDN is a natural by-product of the organization of the motor-unit pool (orderly recruitment by twitch amplitude) acting peripherally ( 17 ). In fact, it appears that there is a trade off between movement stability and SDN ( 18 ), which explains why people not always choose the most stable strategy (highest stiffness) if it introduces too much variability. The natural age-related deterioration of the neuromuscular system likely makes older adults with CLBP less able to find the best trade off. One way to at least partly circumvent this problem would be to passively increase spine stiffness using a lumbosacral orthosis (LSO; passive method) ( 19 , 20 ), which in turn slightly reduce superficial trunk muscle activation by 1–2% ( 20 , 21 ) and also immediately decreases back pain ( 22 ), all being potentially beneficial in terms of balance control. Alternatively, the abdominal drawing-in maneuver (ADIM), by isolating the contraction of the transversus abdominis (TrA) and internal oblique deep abdominal muscles, enhance lumbar stiffness/stability through feedforward motor control ( 20 ) without increasing back loading. This increases the tension of the thoracolumbar fascia and intra-abdominal pressure, transforming the abdomen into a rigid cylinder, thus increasing lumbar stability ( 23 , 24 ). This may involve the adverse effect of SDN but may also immediately reduce back pain, the net response of these two potentially opposing effects on postural balance remaining unknown. LSO and ADIM were not influential on balance control during a challenging balance task, as tested in our previous work in young adults with and without CLBP ( 25 , 26 ). However, according to the above-mentioned arguments or possibilities, beneficial effects might occur in older adults and more so if they have CLBP. Consequently, the aim of this study was to evaluate, for the first time, the immediate effect of LSO and ADIM on postural control during semi-tandem stance in older adults with and without CLBP. We hypothesized that these two interventions would be more beneficial in the presence of CLBP. 2. Methods 2.1 Study Design This experimental and comparative study follows a cross-sectional design. 2.2 Participants A total of 57 volunteers aged 65 and over from the Saguenay-Lac-Saint-Jean region in Quebec, Canada, participated in the study. Participants were recruited on a voluntary basis from the University and local community through advertisements in public places and on the BioNR Lab’s social media pages. As no study has yet investigated these two intervention approaches in older adults aged 75 and over, the sample size was estimated based on the sway velocity values reported in individuals with non-specific CLBP (age mean 61 years old) during a challenging balance performance using foam and eyes open (EO) and comparing LSO versus control condition (Foam-EO: 1.34 ± 0.58 vs. 0.91 ± 0.36, p = 0.004; with a large effect size d = 0.91) ( 27 ). According to the sample size calculation (BioStat 5.3.0 – Biology Statistical Software; α = 0.05, power [1-β] = 0.80, bilateral t-test), a minimum of 20 participants per group was required. To be eligible for this study, participants had to ( 1 ) be older (≥ 65 years old); ( 2 ) be able to walk unaided without assistive devices, and ( 3 ) be in good cognitive health: ≥24/30 score based on the French-validated version ( 28 ) of the Mini Mental State Examination (MMSE). Participants were then assigned to 1 of 2 specific groups according to their health status and inclusion criteria as follows: a group without CLBP defined as healthy older adults (n = 35) and a group of older adults with non-specific CLBP (n = 22). The inclusion criteria for the CLBP group were history of lumbar or lumbosacral pain with or without proximal radicular pain and presence of chronic pain defined as daily or almost daily pain for a minimum of 3 months, with previous diagnostic of CLBP by a medical doctor. The inclusion criteria for the healthy group were no history of CLBP (defined as a back pain episode requiring treatment). Potential participants were excluded if they had ( 1 ) any musculoskeletal injuries at the ankle, knee, or hips in the last two years ( 2 ); neuromuscular injury other than CLBP at the time of testing; ( 3 ) history of spine or lower limbs musculoskeletal surgery; ( 4 ) congenital spine abnormalities such as spondylolysis, spinal fusion (spondylodesis), and ankylosing spondylitis or red flags; ( 5 ) systemic disorders that can attack the musculoskeletal, cardiovascular, respiratory, or nervous system (ex: Multiple sclerosis, fibromyalgia,); and ( 7 ) be enrolled in physical activity (three days a week) or rehabilitation programs at the time of the study period. 2.3 Instrumentation for postural control measures The centre of pressure (COP) of a force platform (BIOMEC400, EMG system do Brasil , SP, Ltda) was recorded at 100-Hz sampling frequency. Then, the force signals were filtered with a 35-Hz lowpass second-order Butterworth filter and then converted into the following linear COP parameters using a custom MATLAB software (The Mathworks Inc., Natick, Massachusetts): ( 1 ) Mean amplitude (AMP, cm), representing the root mean square of the absolute distance between maximal and minimal COP displacement; ( 2 ) ellipse area (A-COP, cm 2 ), meaning the total area covered in the sagittal and frontal planes using an ellipse area at 95% of confidence; and ( 3 ) mean sway velocity of COP (VEL, cm/s), representing the sum of the cumulated COP displacement divided by the total time; and mean sway frequency (MF, Hz), representing the number of oscillations per unit of time. These measures were quantified in anteroposterior (A/P) and mediolateral (M/L) directions of movement. The reliability of these COP parameters (ex: area, velocity) is adequate ( 26 ). 2.4 Clinical measures At the beginning of the testing session, for the purpose of describing the older individuals with CLBP, the French versions of the following self-administered questionnaires were completed: (1) The Numeric Pain Rating Scale (NPRS), higher scores denoting more pain ( 29 – 31 ). (2) The Rolland–Morris disability questionnaire (RMDQ), higher scores denoting more disability ( 32 ); (3) The Fear-Avoidance Beliefs Questionnaires for physical activities, higher scores denoting greater fear-avoidance beliefs ( 33 ); and (4) Duration of symptoms (months). The following two assessments were then administered to all participants in this study: (1) The Baecke Physical Activity Questionnaire (BPAQ) to assess habitual physical activity over the past 12 months at work as well as during sports and leisure ( 34 – 36 ). (2) The French-validated version of the Modified-Falls Efficacy Scale (M-FES Fr) ( 37 ), assessing how confident older adults are to undertake 14 daily activities within the past 12 months, higher scores reflecting more confidence and less fear of falling ( 37 ). 2.5 Experimental protocol The experimental protocol began first, with basic anthropometric measures, and participants completed a self-reported sociodemographic and clinical questionnaire. Second, participants were familiarized with the protocol of ADIM performance under submaximal effort (Fig. 1 ). We used a SonoSite M-Turbo ultrasound scanner (M-MSK Ultrasound System; Fujifilm SonoSite Inc. Bothell, Washington) coupled with a 13 − 6 MHz linear transducer ( 38 , 39 ) to provide feedback on the actual contraction of the transversus abdominis muscle during the muscle activation training session (Fig. 1 ). Third, participants were familiarized with the three randomly allocated experimental conditions, including one control (without any assistance) and two lumbar stabilization approaches (Fig. 1 A: LSO and 1B: ADIM), with three to five semi-tandem balance trials for each condition. The semi-tandem stance task (Fig. 2 ) was chosen because it is one of the most sensitive and challenging for detecting differences in postural control involving hip/trunk postural strategies ( 40 , 41 ). The semi-tandem stance is a task functionally related to many activities of daily living (ADLs). It challenges balance in a way that closely mimics the postural demands of daily movements, especially those requiring dynamic stability and weight shifting as well as reflects mediolateral stability, which is critical for dynamic mobility like walking, reaching, turning, and stair steps (all core components of functional ADLs) ( 42 ). This task requires more attention, executive control and cognitive effort compared to easier balance tasks as standing in bipodal posture ( 43 ). The inability to hold tandem or semi-tandem stance within a given time limit can the eight-year mortality independently of baseline and follow-up confounders (e.g., health events, including falls during follow-up) in older adults (n = 1300) ( 44 ). The experimental balance protocol was the same as in our previous works ( 25 , 26 ). For each experimental condition, participants performed 2 trials lasting 30 seconds each with eyes open (30 seconds of rest between each trial) and they were instructed to maintain their semi-tandem balance across this time-series, with arms along the body, while looking at a target at eye level, placed at a distance of 2 m (Fig. 2 ). Participants were allowed to rest for 2 minutes (recommended seated) between conditions to minimize peripheral and central fatigue. Participant safety was ensured by a trained evaluator who was positioned near them during all data collection. For all conditions, landmarks on the platform, determined individually, allowed to maintain a constant foot position between trials and conditions. 2.6 Statistical Analysis The average across 2 trials was computed for all COP parameters ( 25 , 26 ). All statistical analyses were performed with SPSS Statistics 26 for Windows (IBM Corp, Armonk, NY), using an alpha of 0.05. The Shapiro-Wilk test was used to confirm the normal data distribution, and the homogeneity of variances was evaluated using Levene’s test. The demographic characteristics between groups were compared using an independent t test; while categorical variable (sex) by Chi-square test. A multivariate analysis of variance (MANOVA) was applied to the seven selected sway parameters simultaneously, considering one between-group factor (GROUP: healthy vs CLBP), one within-group factor (CONDITION: CTL vs LSO vs ADIM) and their interaction (GROUP × CONDITION) effects. A Tukey post hoc test was performed when a significant main CONDITION effect was obtained. Partial eta squared (ηp 2 ) was also obtained from MANOVA output for each factor (GROUP, CONDITION) and their GROUP × CONDITION interaction. When necessary, we used the Cohen’s d effect sizes to determine the magnitude of significant effects and clinical changes from main factors. These size effects were classified with d values as 0.2 = small, 0.5 = medium and 0.8 = large effect sizes ( 45 , 46 ). Finally, the percentage delta (Δ%) was used from average comparisons, which it refers to the percentage change in a measured outcome typically used to quantify the effect or difference between two conditions from a clinical perspective. 3. Results 3.1 Sample characteristics Both groups were homogeneous for demographic and anthropometric measures as well as for physical activity level (Table 1 ). On average, our participants with CLBP experienced moderate pain, mild to moderate disability and fears of physical and work/home activities. The healthy and CLBP groups exhibited equivalent cognitive status and confidence that they would not fall during activities of daily living. The duration of symptoms in CLBP participants was 10 years on average. Table 1 Characteristics of older participants with and without CLBP. Healthy (n = 35) CLBP (n = 22) p value a Demographic/anthropometric data : Age (years) 74.43 ± 7.03 72.50 ± 4.95 0.271 Sex (male), n (%) 15 (43.0%) 12 (46.0%) 0.852 a Height (cm) 164 ± 0.09 165 ± 0.10 0.787 Weight (kg) 70.61 ± 13.89 77.65 ± 18.85 0.113 Body mass index (kg/m 2 ) 26.11 ± 3.93 28.64 ± 6.95 0.117 Clinical data : MMSE (score/30) 28.94 ± 1.24 28.82 ± 1.56 0.741 M-FES Fr (score/140) 137.81 ± 5.93 133.53 ± 12.47 0.584 Baecke index : Global (score/15) 9.23 ± 1.72 9.15 ± 2.90 0.911 Work (score/5) 2.73 ± 0.53 2.90 ± 0.69 0.314 Sports (score/5) 3.19 ± 0.84 2.93 ± 1.16 0.342 Leisure time (score/5) 3.31 ± 0.73 2.91 ± 0.85 0.068 CLBP clinical status : NPRS (score/10) / 5.32 ± 1.84 / RMDQ (score/24) / 5.36 ± 3.80 / FABQ-PA (score/24) / 9.09 ± 7.58 / FABQ-W (score/42) / 13 ± 12.57 / Pain duration (months) / 125 ± 108 / Mean and standard deviation (±) related to continuous and categorical (sex) variables. a p values from independent t-test and Chi-square test for sex comparison. CLBP: Chronic low back pain; MMSE: Mini Mental State Examination; M-FES Fr: The Modified Falls Efficacy Scale- French version; FABQ-PA: Fear-Avoidance Beliefs Questionnaire - Physical Activity; FABQ-W: Fear-Avoidance Beliefs Questionnaire − Work; NPRS: Numeric Pain Rating Scale; RMDQ: Roland-Morris Disability Questionnaire. 3.2 Effects on postural control from GROUP and CONDITION factors As reported in Table 2 (descriptive statistics) and Table 3 (MANOVA results), no interaction effects ( p > 0.05) were observed between conditions (CTL, ADIM, LSO) and groups (CLBP, Healthy) for all COP variables, allowing to interpret main effects independently. A significant GROUP effect (CLBP > Healthy; suggesting poor postural control in CLBP) was pointed out for amplitudes (in mean 8 to 12% across A/P and M/L directions) and ellipse area of COP (in mean 16%), with η p 2 effect sizes varying from 0.02 to 0.05. Table 2 Descriptive data of COP parameters between groups across three experimental conditions. Experimental conditions (Mean ± SD) CTL ADIM LSO AMP A/P(cm) Healthy 2.01 ± 0.42 2.43 ± 0.77 2.00 ± 0.44 CLBP 2.13 ± 0.50 2.69 ± 0.49 2.13 ± 0.39 Total 2.06 ± 0.45 2.53 ± 0.68 2.05 ± 0.43 AMP M/L (cm) Healthy 2.93 ± 0.69 2.96 ± 0.69 2.89 ± 0.61 CLBP 3.10 ± 0.79 3.60 ± 0.85 3.08 ± 0.62 Total 3.00 ± 0.73 3.21 ± 0.81 2.96 ± 0.62 A-COP (cm 2 ) Healthy 4.22 ± 1.44 5.71 ± 2.95 4.43 ± 1.79 CLBP 4.90 ± 2.04 7.03 ± 2.85 4.79 ± 1.84 Total 4.49 ± 1.71 6.22 ± 2.96 4.57 ± 1.80 VEL A/P (cm/s) Healthy 1.87 ± 0.70 1.80 ± 0.53 1.58 ± 0.39 CLBP 1.83 ± 0.62 2.02 ± 0.55 1.67 ± 0.33 Total 1.85 ± 0.67 1.89 ± 0.54 1.61 ± 0.37 VEL M/L (cm/s) Healthy 2.22 ± 0.63 2.16 ± 0.52 2.07 ± 0.40 CLBP 2.22 ± 0.64 2.41 ± 0.71 2.15 ± 0.56 Total 2.22 ± 0.63 2.26 ± 0.61 2.10 ± 0.46 MF A/P (Hz) Healthy 0.66 ± 0.19 0.68 ± 0.23 0.65 ± 0.18 CLBP 0.70 ± 0.24 0.68 ± 0.19 0.59 ± 0.19 Total 0.68 ± 0.21 0.68 ± 0.21 0.63 ± 0.19 MF M/L (Hz) Healthy 0.58 ± 0.14 0.59 ± 0.13 0.56 ± 0.14 CLBP 0.53 ± 0.12 0.56 ± 0.16 0.55 ± 0.13 Total 0.56 ± 0.13 0.58 ± 0.14 0.56 ± 0.13 Data are mean and standard deviation (±). COP linear Variables area: Amplitude (AMP) in anteroposterior (A/P) and mediolateral (M/L), area ellipse of COP (A-COP), velocity sway of COP (VEL) in A/P and M/L, mean frequency (MF) in A/P and in M/L. Experimental conditions: ( 1 ) control - without lumbar stabilization (CTL), ( 2 ) wearing of lumbosacral orthoses (LSO) and ( 3 ) activation of the transversus abdominis (TrA) muscle by the abdominal drawing-in maneuver (ADIM). Table 3 Results from 2-way MANOVA (p values) and Tukey’s post hoc tests on main factors analysed (GROUP and CONDITION). p-value (η p 2 ) Tukey’s post hoc GROUP CONDITION † INTERACTION CONDITION factor AMP A/P 0.460* (0.024) CTL, LSO AMP M/L 0.003* (0.052) 0.055 (0.034) 0.149 (0.023) A-COP 0.025* (0.030) CTL, LSO VEL A/P 0.308 (0.006) 0.020* (0.046) 0.462 (0.009) LSO < CTL, ADIM VEL M/L 0.227 (0.009) 0.275 (0.016) 0.508 (0.008) MF A/P 0.829 (0.001) 0.233 (0.018) 0.415 (0.011) MF M/L 0.141 (0.013) 0.743 (0.004) 0.727 (0.004) † Statistically significant (p < 0.02) condition effects, which are also illustrated in Fig. 3 . * Statistically significant (p < 0.03). η p 2 : Partial Eta Squared effect size from MANOVA results COP linear Variables area: Amplitude (AMP) in anteroposterior (A/P) and mediolateral (M/L), area ellipse of COP (A-COP), velocity sway of COP (VEL) in A/P and M/L, mean frequency (MF) in A/P and in M/L. Experimental conditions: ( 1 ) control - without lumbar stabilization (CTL), ( 2 ) wearing of lumbosacral orthoses (LSO) and ( 3 ) activation of the transversus abdominis (TrA) muscle by the abdominal drawing-in maneuver (ADIM). Significant effects on the CONDITION factor were observed for 3/7 COP parameters (Fig. 3 ), with effect sizes (η p 2 ) ranging from 0.05 to 0.16. Post hoc analyses revealed better postural control during the LSO condition, related to low COP values in VEL A/P, as compared to CTL ( d = 0.36; Δ%= 13) and ADIM ( d = 0.50; Δ%= 15) conditions (see Fig. 3 C). A deterioration of postural control was observed during the ADIM condition (with higher COP values) as compared to CTL and LSO, mainly for amplitude A/P and area ellipse of COP (A-COP), with largest effect sizes ranging between d = 0.92 and 1.13 as well as Δ% ranging from 13 to 39% across conditions (Fig. 3 A and B). For (a): significant differences reported between CTL and ADIM in 2 COP variables (Graphs A and B) and afterward between CTL and LSO in VEL variable (Graph C). For (b): significant differences reported between ADIM with LSO for 3 COP variables (Graphs A, B, C). 4. Discussion The main findings were as follows: ( 1 ) no GROUP × CONDITION were observed for any COP variables, which aligns with our previous studies ( 25 , 26 ); ( 2 ) as expected, CLBP exhibited poorer postural control than the healthy individuals; and ( 3 ) the LSO approach improved postural control, while ADIM deteriorated it comparatively to the other two conditions. Our hypothesis was then partially confirmed. Considering that there were no significant GROUP × CONDITION interactions, the presence of pain per se, as well as the capacity of an LSO ( 22 ), and possibly the ADIM (unknown to the authors) to immediately reduce pain, cannot explain the differential effects generated by the LSO and ADIM on postural control. The absence of GROUP × CONDITION interactions also allows us to examine the main factors independently, as follows. 4.1 CLBP effects on postural control Our study once again confirmed that individuals with CLBP have poorer postural control. Since 2011, these results have been evidenced by three systematic reviews ( 47 – 49 ) and, more recently, by a meta-analysis ( 5 ). To our knowledge, only one review has been conducted on this topic among older adults, which also confirmed this result ( 6 ). Overall, older adults with CLBP have a significantly larger area of COP and higher velocity sway of COP in the anteroposterior and mediolateral directions ( 6 ). This concurs with our findings for the following 3/7 COP parameters: amplitude A/P (mean difference: 8%), M/L (mean difference: 12%) and COP ellipse area (mean difference: 16%). This is also consistent with our previous studies in older adults with CLBP during different balance tasks ( 50 , 51 ). As evidenced in this literature, differences between CLBP and healthy individuals occur during more challenging balance tasks ( 5 ), the larger effect sizes highlighting the clinical relevance of this finding. For example, the semi-tandem and one-legged stances are the two most discriminant tasks, with d -values greater than 1.48, regardless of whether vision is occluded or not during the test ( 40 ). We chose the semi-tandem task because it is functionally related to many ADLs and close to tandem that is a strong predictor of mortality in older adults ( 42 , 44 ). In general, these two balance tasks can activate the hip and trunk strategy more than the ankle strategy ( 41 , 52 ), possibly offering more opportunities to observe differences related to the presence of CLBP. Even if there was a possible shift of strategy from the hip/trunk to the ankle with low back pain, as Brumagne suggests based on young adults findings ( 53 ), our results consistently showed effects in both directions of movement (amplitude A/P and M/L). Furthermore, the changes in trunk function with age could explain the discrepancies reported in the literature regarding the impact of chronic pain on postural control of young compared to older adults ( 54 – 57 ). According to a recent review on this topic ( 5 ), the following key mechanisms may have mediated the differences between individuals with and without CLBP in our study with regard to postural control: ( 1 ) an altered sensory integration or motor control impairment; ( 2 ) a shift in postural control strategy (as Brumagne suggests); ( 3 ) a trunk stiffening and reduced spine mobility; ( 4 ) an increased motion perception threshold with pain; and ( 5 ) a context-dependent sway pattern, where the magnitude of sway increases when vision is obstructed, the surface is unstable, or self-reported pain levels are higher. Of special interest, in line with the above-mentioned trunk stiffening / reduced mobility mechanism, altered trunk muscle activation (i.e., agonist, antagonist, or co-activation) occurs in individuals with CLBP during balance standing ( 58 , 59 ) and reaching balance tests ( 60 ), and which was also observed in older individuals during one-legged stance balance ( 16 ). 4.3 Effects of lumbar stabilization approaches on postural control The most important result of this study was the opposite effects, according to different COP sway parameters, of the two approaches to increase lumbar stability on postural control in older individuals (LSO = positive; ADIM = negative), regardless of the presence of CLBP. As such, these effects will be discussed separately. 4.3.1 LSO effects on postural control LSO reduced COP sway velocity values by 13 to 15% ( d = 0.36 to 0.50; Fig. 3 C) compared to the other two conditions, which differs from studies in young adults performing the semi-tandem and one-legged stance tasks ( 25 , 26 ) where no effect was observed, but consistent with ( 27 ). Mi et al., (2018) evaluated more or less young adults (mean age 60 years), namely 28 with and 28 without low back pain during four balance tasks (with and without foam; with eyes open and closed) on a force platform. The LSO also decreased COP velocity values of both groups in the most difficult balance tasks (e.g., with foam, eyes open or closed) which supports our findings. It should be noted that the COP velocity variable is one of the most reliable and sensitive parameters to assess balance in young and older adults ( 61 – 64 ). Several mechanisms may explain the positive effect of LSO on postural control, but referring to previous studies is difficult given their heterogeneity in terms of population (young vs older adults), posture adopted for postural control (standing vs sitting), task difficulty (manipulation of vision and proprioception) and reported COP variables (linear vs non-linear, etc.). Effectively, the effect of LSO on postural control has often been studied during sitting on an unstable chair ( 65 – 70 ), which is a completely different paradigm not involving lower limbs. It is also difficult to definitively conclude that a single mechanism is involved or override others. The first possible mechanism is mechanical of nature, namely through the increase of lumbar stiffness ( 19 , 20 ), as even for small trunk flexion angles, as during the semi-tandem stance, an LSO reduces the lumbar ROM while not affecting the pelvis (or hip joints) ( 22 ). The freedom of the pelvis is essential to engage postural strategies initiated from hip muscles when standing, especially in a more challenging tasks such as semi-tandem stance ( 41 , 71 ). When standing, some deeper stabilising trunk muscles such as lumbar multifidus and abdominals of the lateral wall may be slightly inhibited by the use of an LSO on an immediate basis, which may explain why some atrophy was observed on a long term basis ( 72 ), but this likely does not affect the more superficial back muscles ( 73 ) and hip extensors generating the required trunk extensors moments for postural correction using the hip strategy ( 41 ). Furthermore, the mechanical effect of a LSO at the lumbar level could optimise the energy cost and control required for postural control using these muscles, particularly in older people, thereby facilitating standing balance performance. Effectively, it has been hypothesized that the effort and energy expended by active muscles car be oriented towards directions relevant to the task ( 74 ). This hypothesis is supported by the immediate effects of using an LSO on the anticipatory postural adjustments of superficial back muscles, as the mechanical effect of the LSO reduced the participation (delayed onset activity) of only the back muscles (left iliocostalis lumborum) responsible to counteract the trunk perturbation induced by the rapid and volitional right flexion of the arm ( 75 ). This phenomenon of cost control optimization (possible energy savings with LSO) involves targeting active muscles to ensure they use the correct amount of energy in the right place, enabling the necessary postural corrections and adjustments to be made according to the difficulty of the task. This mechanical input is particularly important for older people, who often have motor deficits and are sensitive to SDN ( 11 , 12 ). An LSO can also affect sensorimotor functions such as lumbar proprioception, anticipatory postural adjustments (predictable trunk perturbations) and back muscle reflexes (unpredictable trunk perturbations) in some way. Although there are some controversial findings, a review concluded that a LSO improves lumbar proprioception of healthy and LBP adults in terms of joint position sense ( 76 ). However, the target - matching task in these studies were not in the neutral spine posture, making thus it difficult to explain the benefit of an LSO during a task in the standing posture like ours. An LSO has been shown to affect anticipatory postural adjustments, but the effect sizes were low in all cases ( 75 ). Finally, the effect of LSO on trunk muscle reflexes is even more inconclusive ( 19 ). Thus, we argue that, overall, the possible subtle effects of LSO on certain sensorimotor functions are not responsible for the observed effects on postural control. 4.3.2 ADIM effects on postural control Unexpectedly, a deterioration in postural control was observed during the ADIM condition compared to the CTL and LSO conditions, with the largest effect sizes ( d = 0.92 to 1.13). These effects were clinically relevant, reaching 13 to 39% across the comparison conditions (see Fig. 3 A and B). Interestingly, the ADIM generates equivalent lumbar stiffness than an LSO ( 20 ), excluding the amount of lumbar stiffness as a possible explanation for their differential effects on postural control. Two mutually exclusive, and possibly additive explanations may explain this finding, namely the SDN (see introduction) and cognitive load induced by the ADIM during, both being potentially more influential in older people (with and without CLBP) and during a challenging balance task (semi-tandem here). This would also explain why ADIM did not affect postural control in our previous studies in young adults (with and without CLBP) using semi-tandem and one-legged stance ( 25 , 26 ). With regard to the SDN hypothesis, our results are in agreement with those observed by one past study ( 68 ) when assessing balance performance on an unstable seat. These authors evaluated the postural control of ten healthy and young individuals in four randomised conditions: normal balancing (the control condition); trunk muscle co-activation (active stiffness); arm muscle co-activation (attention control); and wearing a belt (passive stiffness). They demonstrated that trunk muscle co-activation resulted in significantly higher COP sway velocity than the control and arm co-activation conditions, thus leaving the SDN phenomenon as a valuable explanation (detailed in the introduction). SDN that may also arise from trunk muscle co-activation corresponding to the ADIM, even if it involves more targeted deep abdominals. Furthermore, the fact that motor noise increases with aging ( 11 , 12 ) may explain why this negative effect of ADIM was only observed in the present study, not in our previous studies in young adults ( 25 , 26 ). Dual tasking, that is performing a cognitive task concomitantly with a task challenging motor control, represents a complementary explanation to SDN to explain deterioration of postural control during the ADIM condition. Effectively, it is very challenging for an older person to perform the ADIM task adequately while maintaining am already difficult semi-tandem stance task, as this requires additional cognitive effort and as such, can affect postural control performance ( 77 ). In other words, postural control and cognitive activities may compete for the limited attentional resources, reducing the resources assigned to each task and thus decreasing balance performance. Effectively, an increased cognitive load has been shown to affect two basic control mechanisms of postural balance by delaying the onset of anticipatory postural adjustments (feedforward control) in CLBP individuals ( 78 ), while not in healthy controls ( 79 ), and by delaying reflex responses (feedback control) of healthy individuals ( 80 ). These detrimental effects of increased cognitive load may affect more older people, especially when there is some cognitive decline. A systematic review and meta-analysis concluded that dual tasking do not affect balance control during easy balance tasks ( 81 ), but this might be different during more challenging balance tasks that pose a risk of falling for older people, as in the present study. Interestingly, it seems that a positive effect of ADIM on balance can be achieved after training on a long-term basis, as shown in different studies involving young adults. Effectively, training the lumbar stabilisers (including the TrA muscle) five times a week for four weeks reduced COP excursions in the anteroposterior direction in young adults with CLBP ( 82 ). Another four-week intervention, but involving ADIM only, also improved postural control of healthy adults ( 83 ), while two weeks of 20-minute daily ADIM training sessions were enough to reduce COP sway measures during a one-legged balance, also in young adults with core instability ( 84 ). Therefore, although we do not recommend the ADIM to older people for its immediate effect on postural control (negative effect), it is not excluded that long-term training of ADIM may lead to an automatic use of the ADIM during daily activities, thus without its volitional and associated detrimental cognitive load, which would improve their postural control and consequently prevent them from falling in the future. Although this has been shown possible in people with stroke ( 85 ), which are characterized by poor trunk stabilization control and balance instability, this will also need to be shown in older adults without such neuromuscular diseases before making this recommendation. 4.4 Implications The effects observed for LSO are clinically relevant (15% of reduction of COP velocity) for older adults. These results have implications for geriatric rehabilitation and fall prevention. Postural imbalance is one of the most important contributing factors to falls in the older people ( 86 , 87 ). The LSO could therefore assist with this process by providing proprioception, providing comfort, safety and pain reduction, or simply by offering stability when necessary for functional balance activities performed in their daily lives. Unfortunately, it is not possible to identify a single mechanism behind these results. It is worth noting that our observations were made in the short term and that significant results were found for 3/7 COP parameters (1/7 for LSO and 2/7 for ADIM). As this is the first demonstration of this phenomenon in older adults, further studies are needed to explore the real clinical implications of LSO within geriatric health services. A systematic review with meta-analysis ( 73 ) concluded that wearing an LSO has no long-term detrimental effects on muscle strength. This is important for older population, who experience changes to their nervous and muscular systems associated with ageing, such as sarcopenia. Conclusion CLBP negatively affects postural control, increasing the risk of falls in older people. LSO immediately improves postural control in older adults with and without CLBP during the semi-tandem balance performance, while ADIM degraded performance. Therefore, the LSO approach could be used as an alternative intervention in a rehabilitation programme for older people with and without CLBP when balance training is a concern on a perspective of fall prevention. Abbreviations A/P Anteroposterior direction of movement A-COP Ellipse area ADIM Abdominal drawing-in maneuver AMP Mean amplitude BPAQ Baecke Physical Activity Questionnaire CLBP Chronic low back pain COP Centre of pressure CTL Control FABQ Fear-Avoidance Beliefs Questionnaires LSO Lumbosacral orthosis M/L Mediolateral direction of movement MANOVA Multivariate analysis of variance MF Mean sway frequency M-FES Fr French-validated version of the Modified-Falls Efficacy Scale MMSE Mini Mental State Examination NPRS Numeric Pain Rating Scale RMDQ Rolland–Morris disability questionnaire SDN Signal-dependent noise TrA Contraction of the transversus abdominis VEL Mean sway velocity of COP Declarations Ethics approval and consent to participate Participants provided informed consent and underwent an assessment during a single session at the Université du Québec à Chicoutimi’s (UQAC) physiotherapy clinic. The study was approved by the local ethics committee at UQAC, (#2018 − 176. 602.605.01), which complies with the ethical standards of the Tri-Council Policy Statement (EPTC 2) on ethical standards for research involving humans. EPTC 2 is the Canadian standard inspired by the Declaration of Helsinki. It incorporates the declaration's main principles, such as respect for and well-being of individuals, informed consent, and fairness. Consent for publication This is not applicable because there is no data or image that allows anyone to personally identify our participants. However, we obtained the free and informed consent of the participants selected for this purpose before taking photographs to illustrate the experimental protocol of this study. Competing Interests The authors declare no potential conflict of interest with respect to the research, authorship, and/or publication of this article. Funding This project was funded by the Programme de soutien au développement de la recherche et de la création (PSDrc) - UQAC and Fondation de l’Université du Québec à Chicoutimi (FUQAC) grants; Réseau provincial de recherche en adaptation-réadaptation (REPAR) − 2020–2021 (objectif stratégique B2 du REPAR (Éliminer les obstacles à l’accès, au maintien et au retour au travail de personnes avec une déficience physique. F.C.L.O. received a postdoctoral fellowship from the Fonds de Recherche Québec-Santé (FRQS). Author Contribution Conception: dAR, SN, RDS; Design of the work: dAR, SN, RDS; Analysis: dAR, SN, RDS, CL; Interpretation of data: dAR, SN, RDS, CL, HM; Writing: dAR, SN, RDS, CL, HM; Manuscript revision: dAR, SN, RDS, CL, HM; Approval of the submitted version : dAR, SN, RDS, CL, HM; Software: HM, RDS. Acknowledgement The authors would like to thank Micheline Harvey, the linguistics professional, for revising the English of this manuscript, and all the volunteers for participating in this project. Thanks also to the BioNR laboratory and the Clinique Universitaire de Physiothérapie de l’UQAC for their support in providing the infrastructure and equipment for our study. Data Availability In accordance with the ethical requirements of the study, the anonymized data may be provided upon request to the corresponding author. References de Souza IMB, Sakaguchi TF, Yuan SLK, Matsutani LA, do, Espírito-Santo AS, Pereira CAB et al. Prevalence of low back pain in the elderly population: a systematic review. Clinics (Sao Paulo). 2019;74:e789. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736–47. Parreira P, Maher CG, Steffens D, Hancock MJ, Ferreira ML. Risk factors for low back pain and sciatica: an umbrella review. Spine J. 2018;18(9):1715–21. 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20:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8022404/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8022404/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12891-026-09602-6","type":"published","date":"2026-02-10T15:57:28+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":97736483,"identity":"092474cd-9da1-415e-87fa-160d22a8fecd","added_by":"auto","created_at":"2025-12-08 19:40:40","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1140975,"visible":true,"origin":"","legend":"","description":"","filename":"DAssomptionetal202511122BMC.docx","url":"https://assets-eu.researchsquare.com/files/rs-8022404/v1/f9ae2a36c6698f5b8a674cda.docx"},{"id":97736481,"identity":"559d5c31-cd4e-4d64-ba6e-eba2631e3786","added_by":"auto","created_at":"2025-12-08 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15:35:24","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":56100,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8022404/v1/7669db29bccc701360f76c9a.png"},{"id":97895864,"identity":"527e4f98-bc7d-4205-bccc-d15b1230cd0a","added_by":"auto","created_at":"2025-12-10 15:35:12","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":111544,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8022404/v1/3eb6b28e98a93dbaa77b4d63.png"},{"id":97896500,"identity":"0f5faf8d-75ed-43e4-b76f-9638586d9200","added_by":"auto","created_at":"2025-12-10 15:36:39","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":51287,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8022404/v1/cd4bd4eebab0d1043f64454a.png"},{"id":97736490,"identity":"9c1c7d44-2c7c-42ec-820a-8dacbd461d6d","added_by":"auto","created_at":"2025-12-08 19:40:40","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":193343,"visible":true,"origin":"","legend":"","description":"","filename":"8e380f8abb1e4fbb8b01f06e3670eb381structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8022404/v1/42e7af3f5307be5c01f8c0c8.xml"},{"id":97736492,"identity":"d608dbbc-0d14-48e4-8570-863ad06d5b3b","added_by":"auto","created_at":"2025-12-08 19:40:40","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":206255,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8022404/v1/931065833dafcf0945b45977.html"},{"id":97736479,"identity":"e4a0fb2d-72f2-46d5-8849-63622b5c26bf","added_by":"auto","created_at":"2025-12-08 19:40:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":200498,"visible":true,"origin":"","legend":"\u003cp\u003eLumbar stabilization methods: (A) lumbosacral orthosis (LSO) place in a typical participant. (B) ADIM method where individual did learn with and without isolated contraction of the transversus (TrA) muscle by the abdominal drawing-in maneuver (ADIM) during familiarization. We used the ultrasonography (US) to help the learning. The red arrow in the lower left image indicates resting TrA muscle.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8022404/v1/5bcce13ff86228a41b5edf43.png"},{"id":97736478,"identity":"caf5267e-f103-405a-b706-9522d47bfde5","added_by":"auto","created_at":"2025-12-08 19:40:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":186849,"visible":true,"origin":"","legend":"\u003cp\u003ePostural control measurements during semi-tandem stance balance task: (A) BIOMEC 400 force platform for stabilographic analysis (linear COP variables). (B): Real-time COP variables computed during test such as amplitude A/P and M/L and area sway. (C): Semi-tandem stance related to leg preferred in forward for a typical participant for illustration. During the true testing the participants were asked to stand barefoot, arms relaxed along the trunk, with the eyes open looking at a target on the wall.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8022404/v1/1624358ae721f461e9c50908.png"},{"id":97736480,"identity":"65317ab9-b14d-4b77-8035-9f5fd0ee2c2b","added_by":"auto","created_at":"2025-12-08 19:40:40","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":208755,"visible":true,"origin":"","legend":"\u003cp\u003eCOP data are mean values with standard deviation (in mode error bars). (A): amplitude (AMP) in A/P direction of movement; (B): area ellipse of COP (A-COP); and (C): velocity sway of COP in A/P direction of movement. * Post hoc Tukey significant differences (p \u0026lt; 0.05) revealing in (a) and (b) the effect sizes (Cohen’s d) and ∆% clinical differences between 3 conditions.\u003c/p\u003e\n\u003cp\u003eFor (a): significant differences reported between CTL and ADIM in 2 COP variables (Graphs A and B) and afterward between CTL and LSO in VEL variable (Graph C).\u003c/p\u003e\n\u003cp\u003eFor (b): significant differences reported between ADIM with LSO for 3 COP variables (Graphs A, B, C).\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8022404/v1/bb6bc07133e8c7b630f8f28d.jpg"},{"id":102785279,"identity":"8a562613-9c3a-4f94-bd56-219d969854f9","added_by":"auto","created_at":"2026-02-16 16:04:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1560444,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8022404/v1/c8972641-82fb-4b50-8618-8ab769800c84.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Lumbosacral orthosis can improve postural control in older adults with chronic low back pain","fulltext":[{"header":"1.Introduction","content":"\u003cp\u003eA systematic review, summarizing international data, reported a high prevalence of low back pain (75%) in older adults in developed countries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Although this disorder is multifactorial and often non-specific, age can be one of the most important risk factors for developing chronic low back pain (CLBP) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Multiple mechanisms related to proper aging could explain this high prevalence, such as degenerative changes in spinal discs and joints, loss of muscle mass and function (sarcopenia), lifestyle and altered pain processing in the central nervous system, all contributing to persistent pain in older adults (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough it is not known whether it is a cause or a consequence, some groups of individuals with CLBP are also characterized by balance impairments. This is evidenced in reviews with meta-analyses in young (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) and older adults (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), with the largest effects sizes seen during more challenging balance tasks and when self-reported pain intensity was higher, as least in young adults (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In fact, experimentally induced low back pain in healthy individuals engenders neuromuscular adaptations during different postural perturbation tasks (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Induced pain in the lower limbs also decreases balance control (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) and more so as pain intensity increases (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA better postural control is naturally achieved by increasing joint stiffness, which is possible by cocontracting agonist and antagonist muscles surrounding the joints involved, especially during more difficult balance tasks (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Cocontraction increases joint impedance, which can reduce motor noise (or kinematic variability) by acting as a mechanical filter. Motor noise sometimes increasing with aging (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), older adults have increased levels of cocontraction (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) as a strategy to suppress variability (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Likewise, in response to pain, people with CLBP redistribute muscle activity across back and abdominal trunk muscles in an individual-specific non-stereotypical manner, but all responses increasing spine stability (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Although the link with spine stability was not performed, (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) observed this type of trunk muscles activity redistribution during one-legged stance balance task, people with CLBP and older adults responding differently than their corresponding healthy and young control groups, respectively.\u003c/p\u003e\u003cp\u003eWhether cocontraction strategies are used to protect the lumbar spine from further pain or to improve postural control, the signal-dependent noise (SDN) phenomenon predicts that this may have an opposite effect on postural control because as muscle contraction increases, more variability might be introduced into the movement. Effectively, SDN is a natural by-product of the organization of the motor-unit pool (orderly recruitment by twitch amplitude) acting peripherally (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In fact, it appears that there is a trade off between movement stability and SDN (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), which explains why people not always choose the most stable strategy (highest stiffness) if it introduces too much variability. The natural age-related deterioration of the neuromuscular system likely makes older adults with CLBP less able to find the best trade off.\u003c/p\u003e\u003cp\u003eOne way to at least partly circumvent this problem would be to passively increase spine stiffness using a lumbosacral orthosis (LSO; passive method) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), which in turn slightly reduce superficial trunk muscle activation by 1\u0026ndash;2% (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and also immediately decreases back pain (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), all being potentially beneficial in terms of balance control. Alternatively, the abdominal drawing-in maneuver (ADIM), by isolating the contraction of the transversus abdominis (TrA) and internal oblique deep abdominal muscles, enhance lumbar stiffness/stability through feedforward motor control (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) without increasing back loading. This increases the tension of the thoracolumbar fascia and intra-abdominal pressure, transforming the abdomen into a rigid cylinder, thus increasing lumbar stability (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This may involve the adverse effect of SDN but may also immediately reduce back pain, the net response of these two potentially opposing effects on postural balance remaining unknown.\u003c/p\u003e\u003cp\u003eLSO and ADIM were not influential on balance control during a challenging balance task, as tested in our previous work in young adults with and without CLBP (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). However, according to the above-mentioned arguments or possibilities, beneficial effects might occur in older adults and more so if they have CLBP. Consequently, the aim of this study was to evaluate, for the first time, the immediate effect of LSO and ADIM on postural control during semi-tandem stance in older adults with and without CLBP. We hypothesized that these two interventions would be more beneficial in the presence of CLBP.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study Design\u003c/h2\u003e\u003cp\u003eThis experimental and comparative study follows a cross-sectional design.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Participants\u003c/h2\u003e\u003cp\u003eA total of 57 volunteers aged 65 and over from the Saguenay-Lac-Saint-Jean region in Quebec, Canada, participated in the study. Participants were recruited on a voluntary basis from the University and local community through advertisements in public places and on the BioNR Lab\u0026rsquo;s social media pages. As no study has yet investigated these two intervention approaches in older adults aged 75 and over, the sample size was estimated based on the sway velocity values reported in individuals with non-specific CLBP (age mean 61 years old) during a challenging balance performance using foam and eyes open (EO) and comparing LSO versus control condition (Foam-EO: 1.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58 vs. 0.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004; with a large effect size \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.91) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). According to the sample size calculation (BioStat 5.3.0 \u0026ndash; Biology Statistical Software; α\u0026thinsp;=\u0026thinsp;0.05, power [1-β]\u0026thinsp;=\u0026thinsp;0.80, bilateral t-test), a minimum of 20 participants per group was required.\u003c/p\u003e\u003cp\u003eTo be eligible for this study, participants had to (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) be older (\u0026ge;\u0026thinsp;65 years old); (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) be able to walk unaided without assistive devices, and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) be in good cognitive health: \u0026ge;24/30 score based on the French-validated version (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) of the Mini Mental State Examination (MMSE).\u003c/p\u003e\u003cp\u003eParticipants were then assigned to 1 of 2 specific groups according to their health status and inclusion criteria as follows: a group without CLBP defined as healthy older adults (n\u0026thinsp;=\u0026thinsp;35) and a group of older adults with non-specific CLBP (n\u0026thinsp;=\u0026thinsp;22). The inclusion criteria for the CLBP group were history of lumbar or lumbosacral pain with or without proximal radicular pain and presence of chronic pain defined as daily or almost daily pain for a minimum of 3 months, with previous diagnostic of CLBP by a medical doctor. The inclusion criteria for the healthy group were no history of CLBP (defined as a back pain episode requiring treatment). Potential participants were excluded if they had (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) any musculoskeletal injuries at the ankle, knee, or hips in the last two years (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e); neuromuscular injury other than CLBP at the time of testing; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) history of spine or lower limbs musculoskeletal surgery; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) congenital spine abnormalities such as spondylolysis, spinal fusion (spondylodesis), and ankylosing spondylitis or red flags; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) systemic disorders that can attack the musculoskeletal, cardiovascular, respiratory, or nervous system (ex: Multiple sclerosis, fibromyalgia,); and (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) be enrolled in physical activity (three days a week) or rehabilitation programs at the time of the study period.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Instrumentation for postural control measures\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eThe centre of pressure (COP) of a force platform (BIOMEC400, \u003cem\u003eEMG system do Brasil\u003c/em\u003e, SP, Ltda) was recorded at 100-Hz sampling frequency. Then, the force signals were filtered with a 35-Hz lowpass second-order Butterworth filter and then converted into the following linear COP parameters using a custom MATLAB software (The Mathworks Inc., Natick, Massachusetts): (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Mean amplitude (AMP, cm), representing the root mean square of the absolute distance between maximal and minimal COP displacement; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) ellipse area (A-COP, cm\u003csup\u003e2\u003c/sup\u003e), meaning the total area covered in the sagittal and frontal planes using an ellipse area at 95% of confidence; and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) mean sway velocity of COP (VEL, cm/s), representing the sum of the cumulated COP displacement divided by the total time; and mean sway frequency (MF, Hz), representing the number of oscillations per unit of time. These measures were quantified in anteroposterior (A/P) and mediolateral (M/L) directions of movement. The reliability of these COP parameters (ex: area, velocity) is adequate (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Clinical measures\u003c/h2\u003e\u003cp\u003eAt the beginning of the testing session, for the purpose of describing the older individuals with CLBP, the French versions of the following self-administered questionnaires were completed:\u003c/p\u003e\u003cp\u003e(1) The Numeric Pain Rating Scale (NPRS), higher scores denoting more pain (\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e(2) The Rolland\u0026ndash;Morris disability questionnaire (RMDQ), higher scores denoting more disability (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e);\u003c/p\u003e\u003cp\u003e(3) The Fear-Avoidance Beliefs Questionnaires for physical activities, higher scores denoting greater fear-avoidance beliefs (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e); and\u003c/p\u003e\u003cp\u003e(4) Duration of symptoms (months).\u003c/p\u003e\u003cp\u003eThe following two assessments were then administered to all participants in this study:\u003c/p\u003e\u003cp\u003e(1) The Baecke Physical Activity Questionnaire (BPAQ) to assess habitual physical activity over the past 12 months at work as well as during sports and leisure (\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e(2) The French-validated version of the Modified-Falls Efficacy Scale (M-FES Fr) (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), assessing how confident older adults are to undertake 14 daily activities within the past 12 months, higher scores reflecting more confidence and less fear of falling (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Experimental protocol\u003c/h2\u003e\u003cp\u003eThe experimental protocol began first, with basic anthropometric measures, and participants completed a self-reported sociodemographic and clinical questionnaire. Second, participants were familiarized with the protocol of ADIM performance under submaximal effort (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). We used a SonoSite M-Turbo ultrasound scanner (M-MSK Ultrasound System; Fujifilm SonoSite Inc. Bothell, Washington) coupled with a 13\u0026thinsp;\u0026minus;\u0026thinsp;6 MHz linear transducer (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) to provide feedback on the actual contraction of the transversus abdominis muscle during the muscle activation training session (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Third, participants were familiarized with the three randomly allocated experimental conditions, including one control (without any assistance) and two lumbar stabilization approaches (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA: LSO and 1B: ADIM), with three to five semi-tandem balance trials for each condition.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe semi-tandem stance task (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) was chosen because it is one of the most sensitive and challenging for detecting differences in postural control involving hip/trunk postural strategies (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). The semi-tandem stance is a task functionally related to many activities of daily living (ADLs). It challenges balance in a way that closely mimics the postural demands of daily movements, especially those requiring dynamic stability and weight shifting as well as reflects mediolateral stability, which is critical for dynamic mobility like walking, reaching, turning, and stair steps (all core components of functional ADLs) (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). This task requires more attention, executive control and cognitive effort compared to easier balance tasks as standing in bipodal posture (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). The inability to hold tandem or semi-tandem stance within a given time limit can the eight-year mortality independently of baseline and follow-up confounders (e.g., health events, including falls during follow-up) in older adults (n\u0026thinsp;=\u0026thinsp;1300) (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe experimental balance protocol was the same as in our previous works (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). For each experimental condition, participants performed 2 trials lasting 30 seconds each with eyes open (30 seconds of rest between each trial) and they were instructed to maintain their semi-tandem balance across this time-series, with arms along the body, while looking at a target at eye level, placed at a distance of 2 m (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Participants were allowed to rest for 2 minutes (recommended seated) between conditions to minimize peripheral and central fatigue. Participant safety was ensured by a trained evaluator who was positioned near them during all data collection. For all conditions, landmarks on the platform, determined individually, allowed to maintain a constant foot position between trials and conditions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Statistical Analysis\u003c/h2\u003e\u003cp\u003eThe average across 2 trials was computed for all COP parameters (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). All statistical analyses were performed with SPSS Statistics 26 for Windows (IBM Corp, Armonk, NY), using an alpha of 0.05. The Shapiro-Wilk test was used to confirm the normal data distribution, and the homogeneity of variances was evaluated using Levene\u0026rsquo;s test. The demographic characteristics between groups were compared using an independent t test; while categorical variable (sex) by Chi-square test. A multivariate analysis of variance (MANOVA) was applied to the seven selected sway parameters simultaneously, considering one between-group factor (GROUP: healthy vs CLBP), one within-group factor (CONDITION: CTL vs LSO vs ADIM) and their interaction (GROUP \u0026times; CONDITION) effects. A Tukey post hoc test was performed when a significant main CONDITION effect was obtained. Partial eta squared (ηp\u003csup\u003e2\u003c/sup\u003e) was also obtained from MANOVA output for each factor (GROUP, CONDITION) and their GROUP \u0026times; CONDITION interaction. When necessary, we used the Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e effect sizes to determine the magnitude of significant effects and clinical changes from main factors. These size effects were classified with \u003cem\u003ed\u003c/em\u003e values as 0.2\u0026thinsp;=\u0026thinsp;small, 0.5\u0026thinsp;=\u0026thinsp;medium and 0.8\u0026thinsp;=\u0026thinsp;large effect sizes (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Finally, the percentage delta (Δ%) was used from average comparisons, which it refers to the percentage change in a measured outcome typically used to quantify the effect or difference between two conditions from a clinical perspective.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Sample characteristics\u003c/h2\u003e\u003cp\u003eBoth groups were homogeneous for demographic and anthropometric measures as well as for physical activity level (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). On average, our participants with CLBP experienced moderate pain, mild to moderate disability and fears of physical and work/home activities. The healthy and CLBP groups exhibited equivalent cognitive status and confidence that they would not fall during activities of daily living. The duration of symptoms in CLBP participants was 10 years on average.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of older participants with and without CLBP.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealthy (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCLBP (n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003eDemographic/anthropometric data\u003c/span\u003e:\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74.43\u0026thinsp;\u0026plusmn;\u0026thinsp;7.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.271\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex (male), n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (43.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (46.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.852\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeight (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e164\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e165\u0026thinsp;\u0026plusmn;\u0026thinsp;0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.787\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70.61\u0026thinsp;\u0026plusmn;\u0026thinsp;13.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.65\u0026thinsp;\u0026plusmn;\u0026thinsp;18.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.113\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody mass index (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26.11\u0026thinsp;\u0026plusmn;\u0026thinsp;3.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.64\u0026thinsp;\u0026plusmn;\u0026thinsp;6.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"BoldItalicUnderline\" class=\"BoldItalicUnderline\" name=\"Emphasis\"\u003eClinical data\u003c/span\u003e:\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMMSE (score/30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.741\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM-FES Fr (score/140)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e137.81\u0026thinsp;\u0026plusmn;\u0026thinsp;5.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e133.53\u0026thinsp;\u0026plusmn;\u0026thinsp;12.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.584\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"BoldItalicUnderline\" class=\"BoldItalicUnderline\" name=\"Emphasis\"\u003eBaecke index\u003c/span\u003e:\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlobal (score/15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.911\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork (score/5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.314\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSports (score/5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.342\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeisure time (score/5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.068\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"BoldItalicUnderline\" class=\"BoldItalicUnderline\" name=\"Emphasis\"\u003eCLBP clinical status\u003c/span\u003e:\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNPRS (score/10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRMDQ (score/24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFABQ-PA (score/24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.09\u0026thinsp;\u0026plusmn;\u0026thinsp;7.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFABQ-W (score/42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u0026thinsp;\u0026plusmn;\u0026thinsp;12.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePain duration (months)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125\u0026thinsp;\u0026plusmn;\u0026thinsp;108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMean and standard deviation (\u0026plusmn;) related to continuous and categorical (sex) variables. \u003csup\u003ea\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e values from independent t-test and Chi-square test for sex comparison. CLBP: Chronic low back pain; MMSE: Mini Mental State Examination; M-FES Fr: The Modified Falls Efficacy Scale- French version; FABQ-PA: Fear-Avoidance Beliefs Questionnaire - Physical Activity; FABQ-W: Fear-Avoidance Beliefs Questionnaire\u0026thinsp;\u0026minus;\u0026thinsp;Work; NPRS: Numeric Pain Rating Scale; RMDQ: Roland-Morris Disability Questionnaire.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Effects on postural control from GROUP and CONDITION factors\u003c/h2\u003e\u003cp\u003eAs reported in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e (descriptive statistics) and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e (MANOVA results), no interaction effects (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) were observed between conditions (CTL, ADIM, LSO) and groups (CLBP, Healthy) for all COP variables, allowing to interpret main effects independently. A significant GROUP effect (CLBP\u0026thinsp;\u0026gt;\u0026thinsp;Healthy; suggesting poor postural control in CLBP) was pointed out for amplitudes (in mean 8 to 12% across A/P and M/L directions) and ellipse area of COP (in mean 16%), with η\u003csub\u003ep\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e effect sizes varying from 0.02 to 0.05.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive data of COP parameters between groups across three experimental conditions.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eExperimental conditions (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCTL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eADIM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLSO\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAMP A/P(cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealthy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCLBP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAMP M/L (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealthy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCLBP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eA-COP (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealthy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.71\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCLBP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVEL A/P (cm/s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealthy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCLBP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVEL M/L (cm/s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealthy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCLBP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eMF A/P (Hz)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealthy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCLBP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eMF M/L (Hz)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealthy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCLBP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eData are mean and standard deviation (\u0026plusmn;).\u003c/p\u003e\u003cp\u003eCOP linear Variables area: Amplitude (AMP) in anteroposterior (A/P) and mediolateral (M/L), area ellipse of COP (A-COP), velocity sway of COP (VEL) in A/P and M/L, mean frequency (MF) in A/P and in M/L. Experimental conditions: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) control - without lumbar stabilization (CTL), (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) wearing of lumbosacral orthoses (LSO) and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) activation of the transversus abdominis (TrA) muscle by the abdominal drawing-in maneuver (ADIM).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResults from 2-way MANOVA (p values) and Tukey\u0026rsquo;s post hoc tests on main factors analysed (GROUP and CONDITION).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003ep-value (η\u003csub\u003ep\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTukey\u0026rsquo;s post hoc\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGROUP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCONDITION \u0026dagger;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eINTERACTION\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCONDITION factor\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAMP A/P\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.460* (0.024)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001* (0.159)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.747 (0.004)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eADIM\u0026thinsp;\u0026gt;\u0026thinsp;CTL, LSO\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAMP M/L\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.003* (0.052)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.055 (0.034)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.149 (0.023)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eA-COP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.025* (0.030)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001* (0.124)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.519 (0.008)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eADIM\u0026thinsp;\u0026gt;\u0026thinsp;CTL, LSO\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVEL A/P\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.308 (0.006)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.020* (0.046)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.462 (0.009)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLSO\u0026thinsp;\u0026lt;\u0026thinsp;CTL, ADIM\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVEL M/L\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.227 (0.009)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.275 (0.016)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.508 (0.008)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMF A/P\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.829 (0.001)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.233 (0.018)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.415 (0.011)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMF M/L\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.141 (0.013)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.743 (0.004)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.727 (0.004)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u0026dagger; Statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.02) condition effects, which are also illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e* Statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.03).\u003c/p\u003e\u003cp\u003eη\u003csub\u003ep\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e: \u003cem\u003ePartial Eta\u003c/em\u003e Squared effect size from MANOVA results\u003c/p\u003e\u003cp\u003eCOP linear Variables area: Amplitude (AMP) in anteroposterior (A/P) and mediolateral (M/L), area ellipse of COP (A-COP), velocity sway of COP (VEL) in A/P and M/L, mean frequency (MF) in A/P and in M/L. Experimental conditions: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) control - without lumbar stabilization (CTL), (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) wearing of lumbosacral orthoses (LSO) and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) activation of the transversus abdominis (TrA) muscle by the abdominal drawing-in maneuver (ADIM).\u003c/p\u003e\u003cp\u003eSignificant effects on the CONDITION factor were observed for 3/7 COP parameters (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), with effect sizes (η\u003csub\u003ep\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e) ranging from 0.05 to 0.16. Post hoc analyses revealed better postural control during the LSO condition, related to low COP values in VEL A/P, as compared to CTL (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.36; Δ%= 13) and ADIM (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.50; Δ%= 15) conditions (see Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC). A deterioration of postural control was observed during the ADIM condition (with higher COP values) as compared to CTL and LSO, mainly for amplitude A/P and area ellipse of COP (A-COP), with largest effect sizes ranging between \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.92 and 1.13 as well as Δ% ranging from 13 to 39% across conditions (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA and B).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFor (a): significant differences reported between CTL and ADIM in 2 COP variables (Graphs A and B) and afterward between CTL and LSO in VEL variable (Graph C).\u003c/p\u003e\u003cp\u003eFor (b): significant differences reported between ADIM with LSO for 3 COP variables (Graphs A, B, C).\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe main findings were as follows: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) no GROUP \u0026times; CONDITION were observed for any COP variables, which aligns with our previous studies (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e); (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) as expected, CLBP exhibited poorer postural control than the healthy individuals; and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) the LSO approach improved postural control, while ADIM deteriorated it comparatively to the other two conditions. Our hypothesis was then partially confirmed.\u003c/p\u003e\u003cp\u003eConsidering that there were no significant GROUP \u0026times; CONDITION interactions, the presence of pain per se, as well as the capacity of an LSO (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), and possibly the ADIM (unknown to the authors) to immediately reduce pain, cannot explain the differential effects generated by the LSO and ADIM on postural control. The absence of GROUP \u0026times; CONDITION interactions also allows us to examine the main factors independently, as follows.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e4.1 CLBP effects on postural control\u003c/h2\u003e\u003cp\u003eOur study once again confirmed that individuals with CLBP have poorer postural control. Since 2011, these results have been evidenced by three systematic reviews (\u003cspan additionalcitationids=\"CR48\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e) and, more recently, by a meta-analysis (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). To our knowledge, only one review has been conducted on this topic among older adults, which also confirmed this result (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOverall, older adults with CLBP have a significantly larger area of COP and higher velocity sway of COP in the anteroposterior and mediolateral directions (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). This concurs with our findings for the following 3/7 COP parameters: amplitude A/P (mean difference: 8%), M/L (mean difference: 12%) and COP ellipse area (mean difference: 16%). This is also consistent with our previous studies in older adults with CLBP during different balance tasks (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). As evidenced in this literature, differences between CLBP and healthy individuals occur during more challenging balance tasks (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), the larger effect sizes highlighting the clinical relevance of this finding. For example, the semi-tandem and one-legged stances are the two most discriminant tasks, with \u003cem\u003ed\u003c/em\u003e-values greater than 1.48, regardless of whether vision is occluded or not during the test (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). We chose the semi-tandem task because it is functionally related to many ADLs and close to tandem that is a strong predictor of mortality in older adults (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). In general, these two balance tasks can activate the hip and trunk strategy more than the ankle strategy (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e), possibly offering more opportunities to observe differences related to the presence of CLBP. Even if there was a possible shift of strategy from the hip/trunk to the ankle with low back pain, as Brumagne suggests based on young adults findings (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e), our results consistently showed effects in both directions of movement (amplitude A/P and M/L). Furthermore, the changes in trunk function with age could explain the discrepancies reported in the literature regarding the impact of chronic pain on postural control of young compared to older adults (\u003cspan additionalcitationids=\"CR55 CR56\" citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to a recent review on this topic (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), the following key mechanisms may have mediated the differences between individuals with and without CLBP in our study with regard to postural control: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) an altered sensory integration or motor control impairment; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) a shift in postural control strategy (as Brumagne suggests); (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) a trunk stiffening and reduced spine mobility; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) an increased motion perception threshold with pain; and (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) a context-dependent sway pattern, where the magnitude of sway increases when vision is obstructed, the surface is unstable, or self-reported pain levels are higher. Of special interest, in line with the above-mentioned trunk stiffening / reduced mobility mechanism, altered trunk muscle activation (i.e., agonist, antagonist, or co-activation) occurs in individuals with CLBP during balance standing (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e) and reaching balance tests (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e), and which was also observed in older individuals during one-legged stance balance (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Effects of lumbar stabilization approaches on postural control\u003c/h2\u003e\u003cp\u003eThe most important result of this study was the opposite effects, according to different COP sway parameters, of the two approaches to increase lumbar stability on postural control in older individuals (LSO\u0026thinsp;=\u0026thinsp;positive; ADIM\u0026thinsp;=\u0026thinsp;negative), regardless of the presence of CLBP. As such, these effects will be discussed separately.\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003e4.3.1 LSO effects on postural control\u003c/h2\u003e\u003cp\u003eLSO reduced COP sway velocity values by 13 to 15% (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.36 to 0.50; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC) compared to the other two conditions, which differs from studies in young adults performing the semi-tandem and one-legged stance tasks (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) where no effect was observed, but consistent with (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Mi et al., (2018) evaluated more or less young adults (mean age 60 years), namely 28 with and 28 without low back pain during four balance tasks (with and without foam; with eyes open and closed) on a force platform. The LSO also decreased COP velocity values of both groups in the most difficult balance tasks (e.g., with foam, eyes open or closed) which supports our findings. It should be noted that the COP velocity variable is one of the most reliable and sensitive parameters to assess balance in young and older adults (\u003cspan additionalcitationids=\"CR62 CR63\" citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSeveral mechanisms may explain the positive effect of LSO on postural control, but referring to previous studies is difficult given their heterogeneity in terms of population (young vs older adults), posture adopted for postural control (standing vs sitting), task difficulty (manipulation of vision and proprioception) and reported COP variables (linear vs non-linear, etc.). Effectively, the effect of LSO on postural control has often been studied during sitting on an unstable chair (\u003cspan additionalcitationids=\"CR66 CR67 CR68 CR69\" citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e), which is a completely different paradigm not involving lower limbs. It is also difficult to definitively conclude that a single mechanism is involved or override others.\u003c/p\u003e\u003cp\u003eThe first possible mechanism is mechanical of nature, namely through the increase of lumbar stiffness (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), as even for small trunk flexion angles, as during the semi-tandem stance, an LSO reduces the lumbar ROM while not affecting the pelvis (or hip joints) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The freedom of the pelvis is essential to engage postural strategies initiated from hip muscles when standing, especially in a more challenging tasks such as semi-tandem stance (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e). When standing, some deeper stabilising trunk muscles such as lumbar multifidus and abdominals of the lateral wall may be slightly inhibited by the use of an LSO on an immediate basis, which may explain why some atrophy was observed on a long term basis (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e), but this likely does not affect the more superficial back muscles (\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e) and hip extensors generating the required trunk extensors moments for postural correction using the hip strategy (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Furthermore, the mechanical effect of a LSO at the lumbar level could optimise the energy cost and control required for postural control using these muscles, particularly in older people, thereby facilitating standing balance performance. Effectively, it has been hypothesized that the effort and energy expended by active muscles car be oriented towards directions relevant to the task (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e). This hypothesis is supported by the immediate effects of using an LSO on the anticipatory postural adjustments of superficial back muscles, as the mechanical effect of the LSO reduced the participation (delayed onset activity) of only the back muscles (left iliocostalis lumborum) responsible to counteract the trunk perturbation induced by the rapid and volitional right flexion of the arm (\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e). This phenomenon of cost control optimization (possible energy savings with LSO) involves targeting active muscles to ensure they use the correct amount of energy in the right place, enabling the necessary postural corrections and adjustments to be made according to the difficulty of the task. This mechanical input is particularly important for older people, who often have motor deficits and are sensitive to SDN (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAn LSO can also affect sensorimotor functions such as lumbar proprioception, anticipatory postural adjustments (predictable trunk perturbations) and back muscle reflexes (unpredictable trunk perturbations) in some way. Although there are some controversial findings, a review concluded that a LSO improves lumbar proprioception of healthy and LBP adults in terms of joint position sense (\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e). However, the target - matching task in these studies were not in the neutral spine posture, making thus it difficult to explain the benefit of an LSO during a task in the standing posture like ours. An LSO has been shown to affect anticipatory postural adjustments, but the effect sizes were low in all cases (\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e). Finally, the effect of LSO on trunk muscle reflexes is even more inconclusive (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Thus, we argue that, overall, the possible subtle effects of LSO on certain sensorimotor functions are not responsible for the observed effects on postural control.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003e4.3.2 ADIM effects on postural control\u003c/h2\u003e\u003cp\u003eUnexpectedly, a deterioration in postural control was observed during the ADIM condition compared to the CTL and LSO conditions, with the largest effect sizes (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.92 to 1.13). These effects were clinically relevant, reaching 13 to 39% across the comparison conditions (see Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA and B).\u003c/p\u003e\u003cp\u003eInterestingly, the ADIM generates equivalent lumbar stiffness than an LSO (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), excluding the amount of lumbar stiffness as a possible explanation for their differential effects on postural control.\u003c/p\u003e\u003cp\u003eTwo mutually exclusive, and possibly additive explanations may explain this finding, namely the SDN (see introduction) and cognitive load induced by the ADIM during, both being potentially more influential in older people (with and without CLBP) and during a challenging balance task (semi-tandem here). This would also explain why ADIM did not affect postural control in our previous studies in young adults (with and without CLBP) using semi-tandem and one-legged stance (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWith regard to the SDN hypothesis, our results are in agreement with those observed by one past study (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e) when assessing balance performance on an unstable seat. These authors evaluated the postural control of ten healthy and young individuals in four randomised conditions: normal balancing (the control condition); trunk muscle co-activation (active stiffness); arm muscle co-activation (attention control); and wearing a belt (passive stiffness). They demonstrated that trunk muscle co-activation resulted in significantly higher COP sway velocity than the control and arm co-activation conditions, thus leaving the SDN phenomenon as a valuable explanation (detailed in the introduction). SDN that may also arise from trunk muscle co-activation corresponding to the ADIM, even if it involves more targeted deep abdominals. Furthermore, the fact that motor noise increases with aging (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) may explain why this negative effect of ADIM was only observed in the present study, not in our previous studies in young adults (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDual tasking, that is performing a cognitive task concomitantly with a task challenging motor control, represents a complementary explanation to SDN to explain deterioration of postural control during the ADIM condition. Effectively, it is very challenging for an older person to perform the ADIM task adequately while maintaining am already difficult semi-tandem stance task, as this requires additional cognitive effort and as such, can affect postural control performance (\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e). In other words, postural control and cognitive activities may compete for the limited attentional resources, reducing the resources assigned to each task and thus decreasing balance performance. Effectively, an increased cognitive load has been shown to affect two basic control mechanisms of postural balance by delaying the onset of anticipatory postural adjustments (feedforward control) in CLBP individuals (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e), while not in healthy controls (\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e), and by delaying reflex responses (feedback control) of healthy individuals (\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e). These detrimental effects of increased cognitive load may affect more older people, especially when there is some cognitive decline. A systematic review and meta-analysis concluded that dual tasking do not affect balance control during easy balance tasks (\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e), but this might be different during more challenging balance tasks that pose a risk of falling for older people, as in the present study.\u003c/p\u003e\u003cp\u003eInterestingly, it seems that a positive effect of ADIM on balance can be achieved after training on a long-term basis, as shown in different studies involving young adults. Effectively, training the lumbar stabilisers (including the TrA muscle) five times a week for four weeks reduced COP excursions in the anteroposterior direction in young adults with CLBP (\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e). Another four-week intervention, but involving ADIM only, also improved postural control of healthy adults (\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e), while two weeks of 20-minute daily ADIM training sessions were enough to reduce COP sway measures during a one-legged balance, also in young adults with core instability (\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e). Therefore, although we do not recommend the ADIM to older people for its immediate effect on postural control (negative effect), it is not excluded that long-term training of ADIM may lead to an automatic use of the ADIM during daily activities, thus without its volitional and associated detrimental cognitive load, which would improve their postural control and consequently prevent them from falling in the future. Although this has been shown possible in people with stroke (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e), which are characterized by poor trunk stabilization control and balance instability, this will also need to be shown in older adults without such neuromuscular diseases before making this recommendation.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Implications\u003c/h2\u003e\u003cp\u003eThe effects observed for LSO are clinically relevant (15% of reduction of COP velocity) for older adults. These results have implications for geriatric rehabilitation and fall prevention. Postural imbalance is one of the most important contributing factors to falls in the older people (\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e). The LSO could therefore assist with this process by providing proprioception, providing comfort, safety and pain reduction, or simply by offering stability when necessary for functional balance activities performed in their daily lives. Unfortunately, it is not possible to identify a single mechanism behind these results. It is worth noting that our observations were made in the short term and that significant results were found for 3/7 COP parameters (1/7 for LSO and 2/7 for ADIM). As this is the first demonstration of this phenomenon in older adults, further studies are needed to explore the real clinical implications of LSO within geriatric health services. A systematic review with meta-analysis (\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e) concluded that wearing an LSO has no long-term detrimental effects on muscle strength. This is important for older population, who experience changes to their nervous and muscular systems associated with ageing, such as sarcopenia.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCLBP negatively affects postural control, increasing the risk of falls in older people. LSO immediately improves postural control in older adults with and without CLBP during the semi-tandem balance performance, while ADIM degraded performance. Therefore, the LSO approach could be used as an alternative intervention in a rehabilitation programme for older people with and without CLBP when balance training is a concern on a perspective of fall prevention.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eA/P Anteroposterior direction of movement\u003c/p\u003e\u003cp\u003eA-COP Ellipse area\u003c/p\u003e\u003cp\u003eADIM Abdominal drawing-in maneuver\u003c/p\u003e\u003cp\u003eAMP Mean amplitude\u003c/p\u003e\u003cp\u003eBPAQ Baecke Physical Activity Questionnaire\u003c/p\u003e\u003cp\u003eCLBP Chronic low back pain\u003c/p\u003e\u003cp\u003eCOP Centre of pressure\u003c/p\u003e\u003cp\u003eCTL Control\u003c/p\u003e\u003cp\u003eFABQ Fear-Avoidance Beliefs Questionnaires\u003c/p\u003e\u003cp\u003eLSO Lumbosacral orthosis\u003c/p\u003e\u003cp\u003eM/L Mediolateral direction of movement\u003c/p\u003e\u003cp\u003eMANOVA Multivariate analysis of variance\u003c/p\u003e\u003cp\u003eMF Mean sway frequency\u003c/p\u003e\u003cp\u003eM-FES Fr French-validated version of the Modified-Falls Efficacy Scale\u003c/p\u003e\u003cp\u003eMMSE Mini Mental State Examination\u003c/p\u003e\u003cp\u003eNPRS Numeric Pain Rating Scale\u003c/p\u003e\u003cp\u003eRMDQ Rolland\u0026ndash;Morris disability questionnaire\u003c/p\u003e\u003cp\u003eSDN Signal-dependent noise\u003c/p\u003e\u003cp\u003eTrA Contraction of the transversus abdominis\u003c/p\u003e\u003cp\u003eVEL Mean sway velocity of COP\u003c/p\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e Participants provided informed consent and underwent an assessment during a single session at the Universit\u0026eacute; du Qu\u0026eacute;bec \u0026agrave; Chicoutimi\u0026rsquo;s (UQAC) physiotherapy clinic. The study was approved by the local ethics committee at UQAC, (#2018\u0026thinsp;\u0026minus;\u0026thinsp;176. 602.605.01), which complies with the ethical standards of the Tri-Council Policy Statement (EPTC 2) on ethical standards for research involving humans. EPTC 2 is the Canadian standard inspired by the Declaration of Helsinki. It incorporates the declaration's main principles, such as respect for and well-being of individuals, informed consent, and fairness.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eThis is not applicable because there is no data or image that allows anyone to personally identify our participants. However, we obtained the free and informed consent of the participants selected for this purpose before taking photographs to illustrate the experimental protocol of this study.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eThe authors declare no potential conflict of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis project was funded by the Programme de soutien au d\u0026eacute;veloppement de la recherche et de la cr\u0026eacute;ation (PSDrc) - UQAC and Fondation de l\u0026rsquo;Universit\u0026eacute; du Qu\u0026eacute;bec \u0026agrave; Chicoutimi (FUQAC) grants; R\u0026eacute;seau provincial de recherche en adaptation-r\u0026eacute;adaptation (REPAR) \u0026minus;\u0026thinsp;2020\u0026ndash;2021 (objectif strat\u0026eacute;gique B2 du REPAR (\u0026Eacute;liminer les obstacles \u0026agrave; l\u0026rsquo;acc\u0026egrave;s, au maintien et au retour au travail de personnes avec une d\u0026eacute;ficience physique. F.C.L.O. received a postdoctoral fellowship from the Fonds de Recherche Qu\u0026eacute;bec-Sant\u0026eacute; (FRQS).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConception: dAR, SN, RDS; Design of the work: dAR, SN, RDS; Analysis: dAR, SN, RDS, CL; Interpretation of data: dAR, SN, RDS, CL, HM; Writing: dAR, SN, RDS, CL, HM; Manuscript revision: dAR, SN, RDS, CL, HM; Approval of the submitted version : dAR, SN, RDS, CL, HM; Software: HM, RDS.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank Micheline Harvey, the linguistics professional, for revising the English of this manuscript, and all the volunteers for participating in this project. Thanks also to the BioNR laboratory and the Clinique Universitaire de Physioth\u0026eacute;rapie de l\u0026rsquo;UQAC for their support in providing the infrastructure and equipment for our study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003e In accordance with the ethical requirements of the study, the anonymized data may be provided upon request to the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ede Souza IMB, Sakaguchi TF, Yuan SLK, Matsutani LA, do, Esp\u0026iacute;rito-Santo AS, Pereira CAB et al. Prevalence of low back pain in the elderly population: a systematic review. Clinics (Sao Paulo). 2019;74:e789.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaher C, Underwood M, Buchbinder R. Non-specific low back pain. 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Task-Oriented Training with Abdominal Drawing-in Maneuver in Sitting Position for Trunk Control, Balance, and Activities of Daily Living in Patients with Stroke: A Pilot Randomized Controlled Trial. Healthc (Basel). 2023;11:23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePiirtola M, Era P. Force platform measurements as predictors of falls among older people - a review. Gerontology. 2006;52(1):1\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVieira ER, da Silva RA, Clemson L, Smith ML. Falls. In: Gu D, Dupre ME, editors. Encyclopedia of Gerontology and Population Aging. Cham: Springer International Publishing; 2019. pp. 1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Aging, Lumbar spine, Rehabilitation, Chronic pain, Falls","lastPublishedDoi":"10.21203/rs.3.rs-8022404/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8022404/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOlder adults with chronic low back pain may report poor postural control and increased fall risks. Possible key mechanisms are altered lumbar spine proprioception, stiffness and mobility, which could be enhanced through lumbar stabilization interventions. To evaluate the immediate effects of two lumbar stabilization approaches on postural control measures, namely a lumbosacral orthosis and the abdominal drawing-in maneuver.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e57 older adults (\u0026gt; 65 yrs): 22 with chronic low back pain and 35 healthy controls performed two trials (30 s) of a semi-tandem balance task on a force platform, while three experimental conditions were randomly assessed: 1) control (without lumbar stabilization), 2) lumbosacral orthosis and 3) the abdominal drawing-in maneuver. Linear variables derived from the platform center of pressure were computed (mean amplitude, ellipse area, sway velocity and frequency) as outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo group × condition interactions were significant. However, chronic low back pain individuals showed significantly (\u003cem\u003ep\u003c/em\u003e ≤ .03) poorer postural control than healthy controls for 3/7 center of pressure parameters. Significant experimental condition effects (\u003cem\u003ep\u003c/em\u003e \u0026lt; .01) were also observed. The lumbosacral orthosis reduced center of pressure sway as compared to control (13%) and the abdominal drawing-in maneuver (15%) mainly for sway center of pressure velocity, while the abdominal drawing-in maneuver deteriorated postural control (23 to 39%) comparatively to the other two conditions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLumbosacral orthosis improved postural control across some center of pressure parameters, while the abdominal drawing-in maneuver degraded performance. These results have implications for clinical decision-making to promote fall prevention and sustainable health for older adults with and without chronic low back pain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number: \u003c/strong\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Lumbosacral orthosis can improve postural control in older adults with chronic low back pain","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 19:40:35","doi":"10.21203/rs.3.rs-8022404/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-02T08:36:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-30T12:12:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-17T09:01:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"263285492204165717951105576261998793700","date":"2025-12-16T03:14:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153054804002412990352848060238620732831","date":"2025-12-15T05:20:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"215963583004021100904802064952414679290","date":"2025-12-08T01:03:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-04T06:23:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-04T06:21:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-02T05:22:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-01T16:18:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-12-01T15:55:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"81489bb9-1b05-4baa-9088-720489fd44bc","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T16:01:24+00:00","versionOfRecord":{"articleIdentity":"rs-8022404","link":"https://doi.org/10.1186/s12891-026-09602-6","journal":{"identity":"bmc-musculoskeletal-disorders","isVorOnly":false,"title":"BMC Musculoskeletal Disorders"},"publishedOn":"2026-02-10 15:57:28","publishedOnDateReadable":"February 10th, 2026"},"versionCreatedAt":"2025-12-08 19:40:35","video":"","vorDoi":"10.1186/s12891-026-09602-6","vorDoiUrl":"https://doi.org/10.1186/s12891-026-09602-6","workflowStages":[]},"version":"v1","identity":"rs-8022404","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8022404","identity":"rs-8022404","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}